Chronic Beryllium Disease: Work Environment Management

I’ve been diagnosed with CBD. Can I return to work?

Your ability to return to work after being diagnosed with beryllium sensitization or CBD depends on several factors, including your overall health and the type of work you do. Many individuals with CBD are able to resume a normal work schedule at their current job or a different one, as the disease, and its symptoms, progresses slowly.

Can I still work with or around beryllium?

While there is no level of exposure to beryllium that is considered “safe”, it is thought that exposures below 0.01 microgram per cubic meter as an 8-hour time-weighted average (TWA) may be safe for both sensitized and diseased workers. The use of respirators may be required for some areas or jobs. The employer or industrial hygienist will outline the type of respirator required, when to wear a respirator and how long to wear a respirator. At the present time it is not known whether removal from beryllium exposure changes the risk of developing CBD for a person with beryllium sensitization. It is also not known if removal from beryllium exposure will significantly change the course of illness for people with CBD. Even so, physicians consider it important and prudent for individuals with beryllium sensitization and CBD to minimize their exposure to airborne beryllium. National Jewish Health physicians recommend individuals diagnosed with beryllium sensitization and CBD who continue to work in a beryllium industry to have exposure of no more that 0.01 micrograms per cubic meter of beryllium as an 8-hour time-weighted average.

Because we do not know of a definite "safe" level of exposure below which sensitization and disease do not occur, it is important to limit beryllium exposure to the lowest level possible.

In the workplace, you should:

Substitute another product for beryllium if at all possible.

Avoid cleaning with compressed air and dry sweeping of work areas.

Use engineering controls to contain and limit exposure to beryllium, such as enclosed processes and proper exhaust ventilation.

Use administrative controls to minimize the number of individuals who have access to areas where beryllium is used.

Establish and maintain a respiratory protection program as needed, ensuring respirators fit properly and are used appropriately.

Use skin protection, shower and change clothes before leaving the beryllium area and work facility.

Ensure employees receive regular training on the proper handling of beryllium, proper use of personal protective equipment, as well as the hazards of beryllium exposure.

Monitor the workplace for beryllium through industrial hygiene testing, with air and wipe sampling methods, in areas where beryllium is used currently as well as places where beryllium may have been used in the past.

Conduct medical surveillance on workers at risk for direct and indirect beryllium exposure using the BeLPT.

Link medical surveillance data to industrial hygiene data to identify areas of risk that may be amenable to further control measures.

Dentistry, Beryllium Sensitization and CBD

I have dental work containing a beryllium alloy. Will this cause beryllium sensitization or CBD?

No, the beryllium in dental work such as crowns, bridges or dental plates is infused in the alloy. For that reason there is no risk of beryllium fumes or dust from the dental work becoming airborne allowing it to be inhaled into the lungs. Bridges, crowns, dental plates and other dental work have not been found to cause beryllium sensitization or CBD. However, it has been published that in very rare cases, beryllium in dental work has been shown to cause contact dermatitis (Haberman et al, 1993).

I have been diagnosed with beryllium sensitization or CBD and have dental work. Do I need to get it replaced or tested for beryllium?

No, bridges, crowns, dental plates and other dental work have not been found to worsen beryllium sensitization or CBD.

Working in a dental laboratory:

Dental laboratory technicians that work with alloys containing beryllium or are in the same facility as modified beryllium alloys are at risk for developing beryllium sensitization and chronic beryllium disease, or CBD. It is important to know that no one develops beryllium sensitization unless they are exposed to beryllium. While the amount of beryllium used in dental alloys is small, ranging from 0.05 - 2%, there is still a risk of developing beryllium sensitization or CBD. While altering the alloys, the dust and fumes produced can become aerosolized and if proper care is not taken there is a potential to breathe them in.

It is important to know that no one develops CBD unless they are exposed to beryllium and develop an immune response (beryllium sensitization) to it. CBD may develop after an individual breathes beryllium dust or fumes. Most people who are exposed to beryllium will not experience health effects.

Studies have shown that on average, 1-6% of exposed workers develop beryllium sensitization, although the rates can be as high as 16% among workers with the highest exposures, such as beryllium machinists. Most workers who are going to develop an allergy to beryllium tend to do so early on, but follow up testing over the years continues to identify workers with beryllium sensitization (Schuler, 2008).

The percentage of people with beryllium sensitization who go on to develop CBD is highly variable, ranging from 10-100% in different worker populations. Individuals with very heavy exposure to beryllium, such as machinists, are at great risk. On average, an estimated 40-60% of workers with beryllium sensitization will go on to develop CBD. Factors such as particle size, type of beryllium used, amount and duration of exposure to beryllium, occupation, industry, and genetics may all play a role in determining why some people develop CBD and others do not. Once you are exposed to beryllium, you carry a lifelong risk of developing beryllium sensitization or CBD, even if the exposure amount was small or you are no longer exposed.

This risk applies only to dental labs where beryllium containing alloys are fabricated or modified, not dental offices, where the alloys are not manufactured or altered.